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Abstract:

Abstract: Background: Interventions to influence the time and way to be born have been a global concern for decades. Yet, limited information is available on what drives these interventions and their variation in frequency among countries, institutions, and
practitioners. The objective of this study was to examine to what extent first‐time mothers’ educational achievement contributes to the frequency of childbirth interventions.Methods: Childbirth interventions, including induction of labor, cesarean section, instrumental
delivery, and epidural analgesia, registered by the Flemish Study Center for Perinatal Epidemiology for Belgian‐born nulliparous women from 1999 to 2006, were linked to the level of maternal education, recorded by the Belgian civil birth registration. Education was divided into four
levels based on the highest diploma attained and adjusted for marital and occupational status.Results: Frequencies of all interventions were inversely related to the level of maternal education. The effect remained after adjustment for birth year, maternal age, marital status,
occupation, infant birthweight, gestational age, assisted conception, and type of hospital. Effect sizes between highest and lowest levels of education were relatively small for operative (31% vs 36%) and instrumental vaginal birth (20.7% vs 22.3%) compared with “initiated delivery”
(defined as labor induction and prelabor cesarean section; 30.2% vs 40.3%) and epidural analgesia (66.8% vs 78.0%). The educational gradient in initiated delivery occurred at all gestational ages, contributing to lower gestational age and lower birthweight of term infants with decreasing levels
of education.Conclusions: In an affluent society with universal and equitable access to maternity care, the more educated women are, the more likely they are to have a spontaneous labor and spontaneous birth without intervention. (BIRTH 38:3 September 2011)

Affiliations:1:
Hendrik Cammu is a Professor of Gynecology at the Free University of Brussels, and a member of the Flemish “Studiecentrum voor Perinatale Epidemiologie” Study Center for Perinatal Epidemiology:
, Brussels, Belgium; Guy Martens is
the Data Coordinator at the Study Center for Perinatal Epidemiology, Brussels, Belgium; and Marc J.N.C Keirse is Professor of Obstetrics and Gynaecology at Flinders University, Adelaide, South Australia, and former scientific adviser of the Study Center for Perinatal Epidemiology, Brussels,
Belgium. 2:
Hendrik Cammu is a Professor of Gynecology at the Free University of Brussels, and a member of the Flemish “Studiecentrum voor Perinatale Epidemiologie” Study Center for Perinatal Epidemiology:
, Brussels, Belgium; Guy Martens is the
Data Coordinator at the Study Center for Perinatal Epidemiology, Brussels, Belgium; and Marc J.N.C Keirse is Professor of Obstetrics and Gynaecology at Flinders University, Adelaide, South Australia, and former scientific adviser of the Study Center for Perinatal Epidemiology, Brussels, Belgium. 3:
Hendrik Cammu is a Professor of Gynecology at the Free University of Brussels, and a member of the Flemish “Studiecentrum voor Perinatale Epidemiologie” Study Center for Perinatal Epidemiology:
, Brussels, Belgium; Guy Martens
is the Data Coordinator at the Study Center for Perinatal Epidemiology, Brussels, Belgium; and Marc J.N.C Keirse is Professor of Obstetrics and Gynaecology at Flinders University, Adelaide, South Australia, and former scientific adviser of the Study Center for Perinatal Epidemiology, Brussels,
Belgium.